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Reports Outline Arthroplasty Study Results from Department of Orthopedics (What Financial Incentives Will Be Created by Medicare Bundled Payments for…

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Reports Outline Arthroplasty Study Results from Department of Orthopedics (What Financial Incentives Will Be Created by Medicare Bundled Payments for Total Hip Arthroplasty?)

By a News Reporter-Staff News Editor at Insurance Weekly News -- Investigators publish new report on Arthroplasty. According to news reporting originating from Chapel Hill, North Carolina, by VerticalNews correspondents, research stated, "Bundled payments are gaining popularity in arthroplasty as a tactic for encouraging providers and hospitals to work together to reduce costs. However, this payment model could potentially motivate providers to avoid unprofitable patients, limiting their access to care."

Our news editors obtained a quote from the research from the Department of Orthopedics, "Rigorous risk adjustment can prevent this adverse effect, but most current bundling models use limited, if any, risk-adjustment techniques. This study aims to identify and quantify the financial incentives that are likely to develop with total hip arthroplasty (THA) bundled payments that are not accompanied by comprehensive risk stratification. Financial data were collected for all Medicare-eligible patients (age 65+) undergoing primary unilateral THA at an academic center over a 2-year period (n = 553). Bundles were considered to include operative hospitalizations and unplanned readmissions. Multivariate regression was performed to assess the impact of clinical and demographic factors on the variable cost of THA episodes, including unplanned readmissions. (Variable costs reflect the financial incentives that will emerge under bundled payments). Increased costs were associated with advanced age (P < .001), elevated body mass index (BMI; P = .005), surgery performed for hip fracture (P < .001), higher American Society of Anaesthesiologists (ASA) Physical Classification System grades (P < .001), and MCCs (Medicare modifier for major complications; P< .001). Regression coefficients were $155/y, $107/BMI point, $2775 for fracture cases, $2137/ASA grade, and $4892 for major complications. No association was found between costs and gender or race. If generalizable, our results suggest that Centers for Medicare and Medicaid Services bundled payments encompassing acute inpatient care should be adjusted upward by the aforementioned amounts (regression coefficients above) for advanced age, increasing BMI, cases performed for fractures, elevated ASA grade, and major complications (as defined by Medicare MCC modifiers). Furthermore, these figures likely underestimate costs in many bundling models which incorporate larger proportions of postdischarge care."

According to the news editors, the research concluded: "Failure to adjust for factors affecting costs may create barriers to care for specific patient populations."

For more information on this research see: What Financial Incentives Will Be Created by Medicare Bundled Payments for Total Hip Arthroplasty? Journal of Arthroplasty, 2016;31(9):1885-1889. Journal of Arthroplasty can be contacted at: Churchill Livingstone Inc Medical Publishers, Curtis Center, Independence Square West, Philadelphia, PA 19106-3399, USA. (Elsevier - www.elsevier.com; Journal of Arthroplasty - www.journals.elsevier.com/journal-of-arthroplasty/)